Presentations
- Bedwetting
- Complex automatic behaviours
- Confusion when waking
- Daytime sleepiness
- Difficulty sleeping
- Episodes of incomplete awakening and limited responsiveness
- Inability to move upon falling asleep or waking
- Screaming / Crying when waking
- Sleepwalking
- Vivid dreams that cause feelings of intense fear / anxiety
- Vocalisations during sleep
Conditions
- Catathrenia (sleep-related groaning)
- NREM disorders:
- confusional arousal
- night terrors
- sleepwalking
- somniloquy
- REM disorders:
- nightmare disorder
- sleep paralysis
- Sleep enuresis (bedwetting)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- conduct an appropriate examination
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- establish a differential diagnosis
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- plan and arrange appropriate investigations
- recognise the clinical presentation
- take a comprehensive clinical history
Manage
- involve multidisciplinary teams
- prescribe therapies tailored to patients’ needs and conditions
- provide evidence-based management
- recognise potential complications of disease and its management, and initiate preventative strategies
Consider other factors
- consider age-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
- Sleep-related hallucinations
- Actions of pharmacological agents and their interactions with sleep that may exacerbate parasomnias
- Classification of parasomnias depending on sleep state
- Clinical features for NREM arousal disorders and their variants, such as confusional arousals, sleep terrors, and sleepwalking
- Clinical utility of home videos
- Collaborative investigations with other sub-specialties, such as neurologists, which might include video-telemetry
- Compare the differences between nightmares and sleep terrors
- Contents of the International Classification of Sleep Disorders (ICSD-3)
- Differential diagnoses of parasomnias, including psychiatric disorders and sleep-related hypermotor epilepsy
- Essential features of a sleep study report used in clinical decision making
- Principles of pharmacological and non-pharmacological management of parasomnias
- Review the predisposing factors that may trigger an episode of parasomnia
- Spectrum of parasomnias and the basic features of confusional arousals, sleep terrors, sleepwalking, and age-specific presentation of various parasomnias in paediatric age group
Investigations
- Assess severity of daytime consequences of sleep disorders
- Interpret and report on typical polysomnography (PSG) findings in NREM arousal disorders and seizure disorders
- Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- chin electromyography
- effort parameters
- ECG electroencephalogram (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- measures of CO2
- oxygen saturation
- Interpret video and EEG during a paroxysmal event at night, and report differential diagnosis
- Perform a thorough history, examination, and sleep specific assessment
- Perform the relevant general physical, neurological, and respiratory examinations
- Recognise features which may suggest parasomnia or seizure
- Interpret video and EEG during a paroxysmal event at night, and report differential diagnosis
- Perform a thorough history, examination, and sleep specific assessment
- Perform the relevant general physical, neurological, and respiratory examinations
- Recognise features which may suggest parasomnia or seizure
- Synthesise patient symptoms and signs into a comprehensive differential diagnosis and plan further investigation if needed
- Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour including bedtime routine, screen time and diet
Procedures
- EEG, including full EEG
- PSG
- Apply and locate sensors for monitoring sleep disorders
- Deliver comprehensive sleep education to patients
- Explain non-pharmacological and pharmacological measures for management of NREM parasomnias
- Explain role of video PSG and home video for diagnosis to patients
- Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory to technical and other staff
- Prescribe and monitor drug management
- Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary to patients and carers
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according to age
- use sleep diary information to inform treatment decisions
- Recognise when referral to another specialist is indicated, such as a psychologist, neurologists or nephrologist / urologist (in cases of nocturnal enuresis)
- Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans
